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Cultura Documentos
I
Professor at Department of Pediatric Dentistry, Ribeirão Preto Dental
School, University of São Paulo, Brazil
II
Professor at Department of Restorative Dentistry, Araraquara Dental
School, State University of São Paulo; Visitant Professor of the
Ribeirão Preto Dental School, University of São Paulo, Brazil
ABSTRACT
RESUMO
INTRODUCTION
The second and third maxillary premolars and second, third and
fourth mandibular premolars of three mongrel dogs (age: 12-18
months old; weight: 8-10 kg), totaling 26 teeth were selected for
treatment.
The animals were anesthetized intravenously with 3% sodium
thiopental (30 mg/kg body weight; Thionembutal, Abbot Laboratories,
São Paulo, SP, Brazil). Standardized periapical radiographs were
taken with a Heliodent RX machine (Siemens, Erlanger, Germany)
with 60 kVp, 10 mA and 0.4 s exposure. Ultraspeed periapical film
(Eastman Kodak Corp., Rochester, NY, USA) was used and the
radiographs were processed by the time/temperature method.
After prophylaxis, the dental area was isolated with a rubber dam and
the operative field was disinfected with 2.0% chlorhexidine gluconate.
Two distinct class I cavities were prepared on the occlusal portion,
one mesial and one distal, with a high-speed #1015 round diamond
bur (KG Sorensen, Ind. Com., São Paulo, SP, Brazil) under copious
water spray, creating standardized pulp exposures (1-mm diameter).
Intermittent movements were performed during cavity preparation to
avoid the generation of excessive heat. After pulp exposure, the
cavities were then irrigated with saline (0.9% sodium chlorite,
Glicolabor Ind. Farm. Ltda, São Paulo, SP, Brazil) to control
hemorrhage and remove debris.
Because all variables should be tested in the same animal and in the
different quadrants, each hemiarch was submitted in an alternate
manner to the experimental protocols.
The pulp exposure was dried with sterile cotton pellets. Group I (13
teeth): the exposed pulp tissue was covered with MTA powder mixed
with distilled water at a 3:1 powder:water ratio (MTA, Dentsply, Tulsa
Dental, Tulsa, OK, RJ, USA), according to the manufacturer's
instructions. After initial setting and removal of excess from the cavity
walls, an adhesive system (Prompt L-Pop, Espe Dental AG, Germany)
was applied with microbrushs for 15 s. Gentle air jets were applied
until a thin, shiny, and homogeneous layer was obtained. The
adhesive was cured for 10s (Ultralux Eletronic, Dabi Atlante, Ribeirão
Preto, SP, Brazil).
Group II (13 teeth): the exposed pulp tissue was covered with a
calcium hydroxide paste (0.5 g of calcium hydroxide p.a. Merck,
Germany plus 0.5 mL of distilled water) mixed at the time of the
procedure. A calcium hydroxide cement (Dycal, Dentsply Ind. Com.
Ltda., Petrópolis, RJ, Brazil) was then applied, followed by application
of Prompt L-Pop adhesive system.
Ninety days after the surgical procedure, all teeth were radiographed
in a standard manner, and the animals were killed by anesthetic
overdose. The maxilla and mandible were dissected and sectioned to
obtain individual roots, and the dentin bridging was evaluated
separately for each cavity preparation. Serial 6-µm wide longitudinal
sections were stained with hematoxylin and eosin, Mallory's
Trichrome and Brown and Brenn.
RESULTS
After ninety days, the results were similar (p>0.01) in the 13 pulps
treated with MTA (Figures 1, 2 and 3) and in the 13 pulps treated
with calcium hydroxide (Figures 4, 5 and 6). There was a compact,
thick dentin bridge totally obliterating the pulp exposure, and a layer
of normal odontoblasts under the dentin bridge. The connective pulp
tissue was intact in all specimens with fibroblasts and a moderate
quantity of collagen. There was no inflammation and the connective
tissue was normal. The periapical and apical regions were normal with
cementoblasts in the cementum surface. The alveolar bone had
osteoblasts in the surface and no signs of resorption. The periodontal
ligament, composed of dense vascularized connective tissue, was of
normal thickness with no inflammation. Bacteria were not observed.
DISCUSSION
In the present study, 100% of the specimens capped with MTA and
calcium hydroxide paste presented a compact thick dentine bridge,
normal odontoblastic layer, connective pulp tissue and apical and
periapical regions with no inflammatory response, with no bone,
cementum or dentin resorption.
The formation of dentin adjacent to the MTA occurs due to its sealing
ability, which prevents microleakage, to its biocompatibility, alkalinity,
or due to other properties such as the capacity to stimulate cytokine
release by the bone cells21.
The present study did not show bacteria in any specimen of either
group, which is probably due to the fact that there was no marginal
leakage and that the materials used had antibacterial activity. The pH
of MTA immediately after manipulation with distilled and deionized
water is 10.2, increasing to 12.5 after 3h and then remaining
constant. Similar to calcium hydroxide, the high pH of MTA is
responsible for its antibacterial activity25.
We believe that the excellent results found with MTA and calcium
hydroxide allow its recommendation for direct pulp capping. However,
MTA is expensive and research results are related to short-time
periods. On the other hand, calcium hydroxide has a low cost, is
easily found and has been presenting excellent clinical, radiographic
and histopathologic results over the last 80 years.
CONCLUSION
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